Changing health care quality paradigms: The rise of clinical guidelines and quality measures in American medicine

► Tracks changing paradigms for conceptualizing quality in United States medical journals between 1975 and 2009. ► Documents the growth of clinical guidelines and quality measures as new paradigms for conceptualizing quality. ► Shows persistence of traditional paradigms that highlight physician training and skills as a basis for quality. ► Documents a recursive relationship between changing paradigms and changing policies for managing quality in Medicare.